Provider Demographics
NPI:1386199867
Name:DR. MARK MCDANIELS
Entity Type:Organization
Organization Name:DR. MARK MCDANIELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LUEDEENE
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-271-1515
Mailing Address - Street 1:350 S 38TH CT
Mailing Address - Street 2:SUITE 225
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5777
Mailing Address - Country:US
Mailing Address - Phone:425-271-1515
Mailing Address - Fax:425-228-4146
Practice Address - Street 1:350 S 38TH CT
Practice Address - Street 2:SUITE 225
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5777
Practice Address - Country:US
Practice Address - Phone:425-271-1515
Practice Address - Fax:425-228-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006052302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization